Maximum Out-of-Pocket Limits for Medicare Advantage

Maximum Out-of-Pocket Limits for Medicare Advantage

Wednesday, December 23, 2015 8:48 AM

Out-of-pocket costs are a big concern for Medicare-eligibles as they compare and choose Medicare insurance plans. Even though Medicare plans help cover many costs associated with your medically necessary services and supplies throughout the year, there are out-of-pocket expenses you will be responsible for in addition to any monthly premiums, yearly deductibles, coinsurance or copayments. Any health or prescription drug costs that beneficiaries must pay for on their own because they are not covered by Medicare or other insurance are considered “out-of-pocket” costs.

In order to help ease the stress caused by unexpected and overwhelming medical expenses throughout the year, Medicare Advantage (or Part C) Plans have an annual out-of-pocket limit. In 2015, the out-of-pocket limit set by the federal government is $6,700, but Medicare Advantage Plans can differ in their benefits and costs, including their out-of-pocket limits.

When comparing and ultimately choosing a Medicare Advantage Plan, you should note that out-of-pocket limits will vary. Medicare Advantage Plans can vary in benefits and costs, so it is important to review your own personal coverage needs and financial goals before choosing a plan so you can find the Medicare insurance that will fit your lifestyle and preferences. For instance, some plans may offer a higher premium with a lower out-of-pocket limit. Only you can decide which plan will best meet for your own needs.

Yearly costs may change from year to year, so if you are enrolled in a Medicare Advantage Plan that did not quite meet your needs during this past year due to changes in your health, budget, or lifestyle, you should take the time to review your Summary of Benefits and compare all of your options prior to Medicare’s Annual Election Period, which starts October 15 and ends December 7.

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